Background
Lung cancer, with 1.35 million new cases and causing more than 1 million deaths each year, is the most common cancer and the leading cause of cancer-related deaths worldwide [
1]. Small-cell lung cancer (SCLC), the most aggressive type of lung cancer, constitutes approximately 15-18% of all lung cancers [
2]. According to the Veterans Administration Lung Group system, SCLC is traditionally defined by a two-stage classification system that includes limited disease and extensive disease. At present, chemotherapy remains the first treatment option for SCLC patients. Although 80-90% of SCLC patients are initially responsive to chemotherapy, most of them succumb to the disease within a year due to rapidly developing multidrug resistance (MDR) [
3,
4]. Thus, MDR has become the main obstacle to the treatment of SCLC and a central issue in improving its prognosis.
Kir2.1, encoded by the
KCNJ2 gene, is a member of the classical inwardly rectifying potassium channel family (Kir2 subfamily). It conducts a strong inward rectifier K
+ current in a wide range of tissues and cell types, including neurons, skeletal muscle, cardiac myocytes, and immune system and carcinoma cells [
5]. The
KCNJ2 gene was first cloned by Kubo et al. from a macrophage cell line in 1993 [
6]. Similar to the other members of the Kir family, Kir2.1 is tetrameric, containing two transmembrane helix domains (M1 and M2), an ion-selective P-loop between M1 and M2, and cytoplasmic N- and C-terminal domains. Functionally, Kir2.1 plays a key role in maintaining the resting membrane potential and regulating cellular excitability in SCLC cells, cardiac myocytes, skeletal muscle and neurons [
7-
9]. Changes in the expression levels of K
+ channels induced by aberrant
KCNJ2 expression have substantial effects on cellular processes such as cell death, apoptosis, proliferation and adhesion, which is linked to a variety of cardiac and neurological disorders [
10-
15]. Human SCLC cells are suggested to be of neurorctodermal origin and exhibit electrophysiological characteristics typical of neuroendocrine cells. Previous studies have indicated that the large, inwardly rectifying K+ current is generated by Kir2.1 and may be associated with SCLC cell MDR [
16,
17]. However, whether Kir2.1 can regulate MDR and its underlying mechanisms remain poorly understood in SCLC.
MicroRNAs (miRNAs) are a class of small, non-coding RNAs of 18–24 nucleotides in length that negatively regulate the expression of specific genes by binding to the 3′ untranslated region (3’UTR) of an mRNA, leading to either translational inhibition or mRNA degradation [
18]. Recent evidence has shown that more than 50% of miRNAs are located in cancer-associated genomic break points and can function as tumor suppressor genes or oncogenes depending on their targets [
19,
20]. Moreover, extensive studies have indicated that miRNAs are closely related to responses to chemotherapeutic treatment [
21-
24]. For example, Yang et al. reported that miR-214 induced cell survival and cisplatin resistance in ovarian cancer [
25]. Additionally, miR-650 levels affected the chemosensitivity of lung adenocarcinoma cells to docetaxel via Bcl-2/Bax expression regulation by directly targeting ING4 [
23], and suppression of miR-137 expression in a drug-resistant SCLC cell line increased its sensitivity to cisplatin [
26]. Moreover, our previous miRNA expression profile study revealed that the expression of 61/852 miRNAs was significantly increased (>3-fold) in MDR SCLC H69AR cells compared with their drug-sensitive parental cell line H69, suggesting a role for these differentially expressed miRNAs in the development of drug resistance in SCLC cells [
22].
We previously found that KCNJ2 is overexpressed in H69AR cells compared to parental H69 cells, whereas miR-7 is expressed at a lower level in H69AR cells compared with H69 cells (unpublished data). In the present study, we further investigated the roles of KCNJ2/Kir2.1 in drug resistance using human drug-resistant SCLC cell lines (H69AR and H446AR). The correlation between KCNJ2 expression and clinical drug response was analyzed in SCLC patients. We then validated the interaction between Kir2.1 and MRP1/ABCC1 by co-immunoprecipitation (Co-IP). Furthermore, we showed that KCNJ2 was modulated by the Ras/MAPK pathway and directly targeted by miR-7. Collectively, our results provide a novel explanation for the chemoresistance of SCLC and suggest that KCNJ2/Kir2.1 plays a crucial role in SCLC MDR.
Discussion
Previous studies have revealed that K+ channel blockers inhibit SCLC cell proliferation via membrane depolarization [
16,
28] and that some types of inwardly rectifying K
+channels are involved in SCLC MDR [
16,
29]. In our previous analysis of a cDNA microarray [
22], KCNJ2 expression was increased in SCLC multi-drug resistant H69AR cells compared with the parent H69 cell line, suggesting that KCNJ2/Kir2.1 might be relevant in the drug resistance of SCLC. However, the molecular mechanism by which KCNJ2/Kir2.1 exerts a role in the chemoresistance of SCLC was not clear until now. In this study, we showed that the mRNA and protein expression of KCNJ2/Kir2.1 was upregulated in both H69AR and H446AR cells compared with that in their respective parental cells, confirming the results of the SCLC mRNA expression profiling. Moreover, Kir2.1 expression in 52 clinical SCLC tissues was significantly associated with the chemotherapeutic responses of the SCLC patients. To further investigate whether KCNJ2/Kir2.1 regulates MDR, we first established two stable KCNJ2/Kir2.1-overexpressing sublines, H69-KCNJ2 and H446-KCNJ2, and suppressed KCNJ2/Kir2.1 expression in H69AR and H446AR cells by shRNAs specifically targeting
KCNJ2. Next, we examined the effect of KCNJ2/Kir2.1 upregulation and downregulation on the sensitivity of SCLC cells to chemotherapeutic drugs (ADM, CDDP and VP-16). H69AR and H446AR cells became much more sensitive to chemotherapeutic agents than the NC groups after significantly inhibiting KCNJ2/Kir2.1 expression, whereas KCNJ2/Kir2.1 upregulation led to the desensitization of H69 and H446 cells to these drugs. Our findings indicate that KCNJ2/Kir2.1 is closely correlated with chemoresistance and may represent a potential clinical strategy for interfering with chemoresistance in SCLC; however, more clinical data are needed to verify this proposal.
To further investigate the possible mechanism of KCNJ2/Kir2.1 in SCLC chemoresistance, we evaluated the effect of KCNJ2/Kir2.1 on apoptosis and cell cycle control by flow cytometry. Our results indicated that one reason for the resistant phenotype of MDR SCLC cells may be that KCNJ2/Kir2.1 induces cell cycle arrest at the G0/G1 phase and inhibits drug-induced apoptosis. Moreover, consistent with the results obtained in vitro, KCNJ2/Kir2.1 promoted tumor growth in a xenograft nude mouse model. These results suggest that KCNJ2/Kir2.1 may play an oncogenic role in SCLC.
In addition to the potential therapeutic impact of KCNJ2/Kir2.1, our studies shed light on the mechanisms by which KCNJ2/Kir2.1 mediates MDR in SCLC. Several studies have confirmed that MRP1/ABCC1 is highly expressed in H69AR cells [
30,
31], and may be closely related to chemoresistance in SCLC [
22]. Enyeart et al. showed that K
+ channels, including KCNJ2/Kir2.1, might function with MRP1/ABCC1 [
32]. In this study, we first found that MRP1/ABCC1 expression was positively correlated with KCNJ2/Kir2.1in SCLC cells and tissues. To further confirm this relationship, we performed Co-IP and demonstrated that Kir2.1 can interact with MRP1/ABCC1 in H69AR cells. Our data suggest that KCNJ2/Kir2.1 might affect the resistance to chemotherapy via interaction with MRP1/ABCC1 in SCLC cells.
The KCNJ2/Kir2.1 channel is modulated by several factors, including PKC, direct tyrosine kinase phosphorylation, the acidic intracellular pH and AMP-activated protein kinase [
17,
33-
35]. The work reported by Giovannardi et al. has shown that RAS-PKC-MEK signaling is also an important regulator of KCNJ2/Kir2.1 [
5]. In this study, KCNJ2/Kir2.1 expression at the mRNA and protein levels was markedly downregulated in the H69AR and H446AR cells after treatment with staurosporine, a PKC inhibitor, or U0126, a MEK inhibitor. It has been suggested that the KCNJ2/Kir2.1 channel is regulated by the Ras-MAPK pathway. However, whether Ras-MAPK signaling is involved in the mechanism by which KCNJ2/Kir2.1regulates SCLC MDR remains unknown.
miRNAs play an important role in the development of drug resistance in some tumor types [
24,
36], and our previous study showed that some miRNAs are involved in the development of drug resistance in SCLC cells [
22]. Thus, we hypothesized that certain miRNAs could affect chemosensitivity by directly targeting KCNJ2/Kir2.1 in SCLC, and we identified miR-7 as a direct suppressor of KCNJ2/Kir2.1. Recently, miR-7 was reported to be a tumor suppressor due to its abilities to suppress cell growth and metastasis [
37-
39], promote apoptosis and inhibit drug resistance [
40]. Our data showed that an miR-7 agomir or an antagomir led to a significant decrease or increase, respectively, in KCNJ2/Kir2.1 expression at both the mRNA and protein levels in SCLC cells. Luciferase reporter assays demonstrated that miR-7 directly targeted KCNJ2 in H69AR cells, and miR-7 expression was associated with SCLC chemoresistance. In addition, we found that miR-7 downregulation was associated with KCNJ2/Kir2.1 expression and advanced clinicopathological features of SCLC tissues. These findings indicate that KCNJ2/Kir2.1 is directly regulated by miR-7 in SCLC.
In summary, our findings reported here provide a novel mechanism by which KCNJ2/Kir2.1 modulates the sensitivity of SCLC cells to chemotherapeutic drugs, possibly through its regulation of MRP1/ABCC1 and simultaneous regulation by the Ras/MAPK pathway and miR-7. Therefore, our study indicates that KCNJ2/Kir2.1 may be a potential novel target for interfering with chemoresistance in SCLC.
Methods and materials
Tissue specimens
Fifty-two SCLC patient tissue samples were obtained from Zhujiang (Southern Medical University, Guangzhou, China) and Wujing Hospitals (Guangzhou Medical University, Guangzhou, China). All samples were confirmed as SCLC by pathologic examination and were further distinguished as limited disease (25 cases) or extensive disease (27 cases) according to the Veterans Administration Lung Study Group. All patients gave informed consent prior to the collection of specimens according to the institutional guidelines. Tissue samples were snap-frozen in the operating room immediately after surgery, and non-tumor tissues were sent to the pathology department for diagnosis by a board-certified pathologist. The non-tumor tissues (pericarcinomatous tissues) were confirmed to have surrounded the tumor tissue and to be free of cancer cells. A paraffin-embedded tissue specimen was available for each included patient. Under the protocol approved by the Institutional Review Board, informed consent was obtained from the patients or their guardians.
Cells culture and transfection
Human SCLC H69 and H446 cell lines and the drug-resistant H69ARsubline were purchased from American Type Culture Collection (ATCC, USA). The other drug-resistant subline, H446AR, was established in our laboratory by culturing H446 cells in adriamycin (ADM). These cell lines were maintained in RPMI 1640 (GIBCO, Mississauga, Canada) supplemented with 10% heat-inactivated calf serum (HyClone, Logan, UT) and L-glutamine (Beyotime, Jiangsu, China) in an incubator at 37°C with 5% CO2. The H69AR and H446AR cell lines were challenged monthly for maintained resistance to the selected drugs, and their growth and morphology were monitored. The drug-resistant cells were maintained in drug-free medium for at least 2 weeks before any experiment.
For transient miRNAtransfection, cells were placed in standard media without antibiotics for 24 h before being transfected with anmiR-7agomir or antagomir or the corresponding negative controls (GenePharma, Shanghai, China) using Lipofectamine 2000 and OPTI-MEMI (Invitrogen) according to the manufacturer’s protocol. For stable transfections, the KCNJ2 coding region was inserted into pcDNA3.1 (GenePharma) andtransfected into H69 and H446 cells to stably overexpress KCNJ2 (H69-KCNJ2 and H446-KCNJ2). Cells stably transfected with the pcDNA3.1 empty expression vector (Invitrogen) were used as their corresponding negative controls (H69-NC and H446-NC). Positive transfectants were selected with 800 μg/ml geneticin (G418; Invitrogen). The
KCNJ2 gene was knocked down using two different KCNJ2 short-hairpin RNAs (shKCNJ2-1, shKCNJ2-2), which were obtained from GenePharma and transfected into H69AR and H446AR cells (H69AR-shKCNJ2-1, H69AR-shKCNJ2-2, H446AR-shKCNJ2-1 and H446AR-shKCNJ2-2) using Lipofectamine 2000. A negative control shRNA (shNC) was transfected into H69AR and H446AR cells (H69AR-shNC and H446AR-shNC) as the corresponding negative controls for cells transfected with shKCNJ2-1 or shKCNJ2-2. After the cells were treated for 24 h, G418 was used for 1 month to select the transfected cells. The short-hairpin RNAsequences are shown in Additional file
7: Table S2.
Reagents and antibodies
A rabbit anti-human Kir2.1 polyclonal antibody was purchased from Alomone labs (Jerusalem, Israel), andpolyclonal anti-MRP1/ABCC1 and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) monoclonal antibodies were purchased from Santa Cruz Inc. (CA, USA). Horseradish peroxidase (HRP)-labeled goat anti-rabbit immunoglobulin G (IgG) and goat anti-mouse IgG were obtained from Santa Cruz Inc. U0126, the MEK inhibitor, and staurosporine, the PKC inhibitor, were purchased from Selleck Chemicals (Houston, TX, USA). All three chemotherapeutic drugs, Cisplatin (DDP; Shandong, China), Etoposide (VP-16; Jiangsu, China) and Adriamycin (ADM; Jiangsu, China), were obtained from commercial sources and were dissolved according to the manufacturer’s instructions.
RNA isolation, reverse transcription, and quantitative real-time PCR
Total RNA, including miRNA, was extracted from cell lines using TRIzol (Invitrogen) or the miRNeasy kit (Qiagen), according to the manufacturer’s instructions. For formalin-fixed, paraffin-embedded (FFPE) samples, total RNA was extracted from ten to fifteen 10-μm-thick sections usingmiRNeasy FFPE Kit (Qiagen). Total RNA was reverse transcribed using the PrimeScript RT reagent Kit (Takala, Dalian, China), andmiRNA sequence-specific reverse transcription (RT)-PCR for miR-7 and U6 was performed according to the Hairpin-itTMmiRNAs q-PCR quantitation kit and the U6 snRNA real-time PCR normalization kit (GenePharma). Quantitative real-time PCR was carried out using the MX3005 sequence detection system (Stratagene) with SYBR Green according to the manufacturer’s instructions. All primers are listed in Additional file
7: Table S3. GAPDH and U6 were used as endogenous controls. All samples were normalized to the internal controls, and fold changes were calculated through relative quantification (2
-△△Ct) [
41].
Western blotting assay
For western blotting assays, total proteins were extracted from cells using RIPA lysis buffer (Sigma-Aldrich) and quantified using a BCA protein assay kit (Thermo). Total proteins were separated on 8% SDS–PAGE gels before being transferred to polyvinylidenedifluoride membranes (Bio-Rad). After the membranes were blocked with 5% non-fat milk, they were incubated with a rabbit anti-human Kir2.1 polyclonal or mouse anti-human MRP1/ABCC1 polyclonal antibody at 4°C overnight. GAPDH was used as a protein-loading control. After washing with Tris-buffered saline solution containing 0.1% Tween 20 (TBST, Bio-Rad), a peroxidase-linked secondary goat anti-mouse IgG or goat anti-rabbit IgG antibody was incubated with the membranes for 1 h at room temperature. After washing again with TBST, the protein bands were detected by chemiluminescence. The intensities of the protein bands were quantified with the Quantity One software (4.5.0 basic, Bio-Rad).
Immunofluorescence staining
Cells were seeded into 24-well plates for 24 h before being fixed with paraformaldehyde at 4°C for 30 min. After being rinsed in PBS, the cells were incubated with 10% normal calf serum for 30 min to block non-specific IgG binding sites and then incubated with rabbit anti-human Kir2.1 monoclonal antibody (Alomone) (1:100 dilution) at 4°C overnight. A fluorescein isothiocyanate (FITC)-conjugated goat anti-rabbit IgGsecondary antibody (1:100 dilution) was added, and the cells were incubated for 1.5 h in the dark at room temperature. All images were captured using a fluorescence microscope (model Eclipse 660, Nikon, Japan).
In vitro drug sensitivity assay
Cells were reseeded in 96-well plates at a density of 5 × 10
3 per well and treated in medium with ADM, DDP or VP-16 for 24 h. Cell survival was then analyzed via the Cell Counting Kit-8 assay (CCK8, Dojindo Molecular Technologies, Japan) according to the manufacturer’s instructions. The range of drug concentrations was based on earlier studies [
42] and was aimed to obtain IC
50 values for both highly sensitive and resistant cases. After incubation with 10 μl of CCK-8 reagent for 4 h,the absorbance was measuredat 450 nm. The cells incubated without drugs were set at 100% survival and used to calculate the IC
50 of each chemotherapeutic drug
. The assay was carried out in six replicate wells for each sample, and three parallel experiments were conducted.
Flow cytometric analysis
Cells were treated with drugs for 24 h and then collected for apoptosis and cell cycle analyses. Cell apoptosis assays were performed using an Annexin V/propidium iodide (PI) detection kit (Keygene, Nanjing, China) according to the manufacturer’s instructions. For cell cycle analysis, cells were harvested and fixed in 70% ethanol overnight at 4°C. After being washed three times in cold PBS, the cells were incubated with RNase and stained with PI. Cellquest Pro software was used for apoptosis analysis and ModFit LT software was used for analysis of cell cycle. Cells in the quadrant of Annexin V−PI− (lower left) represent viable cells, cells in the quadrant of Annexin V−PI+ (upper left) mean necrotic cells, cells in the quadrant of Annexin V+PI+ (upper right) mean late apoptotic and dead cells and cells in the quadrant of Annexin V+PI− (lower right) represent early apoptotic cells. Usually apoptosis analysis is mainly based on the percentages of Annexin V+PI− cells. All assays were carried out independently in triplicate.
Immunohistochemical analysis
Paraffin-embedded SCLC samples were sectioned and mounted on microscopic slides. Polyclonal anti-Kir2.1 and anti-MRP1/ABCC1 antibodies (Alomone Labs Ltd., Israel) was used as the primary antibodies. Antigen retrieval was performed by microwaving in 10 mmol/L citric acid buffer at pH 7.2. The samples were incubated first with the primary antibodies overnight at 4°C, then with the secondary antibodies for 2 h at room temperature in the same buffer and finally with abiotinylated secondary antibody (DAKO, Tokyo, Japan). The bound antibodies were visualized using the avidinbiotinylated peroxidase complex and diaminobenzidine tetrachloride methods (Santa Cruz Biotechnology).
The IHC-stained samples were independently evaluated for Kir2.1 and ABCC1 expressions by two pathologists blinded to the clinical parameters. The staining intensity was scored as 0 (negative), 1 (weak), 2 (medium) or 3 (strong). The extent of staining was scored as 0 (0-5%), 1 (6-25%), 2 (26-50%) or 3 (51-100%), according to the percentages of the positive stained area in relation to the entire carcinoma-involved area or the entire normal sample area. The sum of the intensity and extent scores was used as the final staining score (0–6). Optimal cut off values were identified; a final staining score ≤ 1 indicated negative expression and a final staining score >1 indicated positive expression.
Luciferase reporter assay
The wildtype and mutated KCNJ23′UTR segments that were predicted to interact with miR-7 were amplified from human genomic DNA by PCR and inserted into psiCHECK-2 immediately downstream of the luciferase stop codon of (Promega) to develop psiCHECK2-KCNJ2-3′UTR and psiCHECK2-KCNJ2-mut-3′UTR. Cells in 24-well plates were transfected with psiCHECK2-KCNJ2-3′UTR, psiCHECK2-KCNJ2-mut-3′UTR or psiCHECK-2. Moreover, anmiR-7 agomir or antagomiror their corresponding negative control (NC agomir or NC antagomir) was also co-transfected into the cells. Luciferase activity was then assayed 48 h posttransfection using a dual-luciferase reporter assay system (Promega).
Co-immunoprecipitation
Cells cultured in 10-cm dishes were harvested and lysed in 500 μl lysis buffer (20 mMTris (pH 7.4), 50 mMNaCl, 1 mM EDTA, 0.5% NP-40, 0.5% SDS, 0.5% deoxycholate, and protease inhibitors). Then, 500 μg lysate (1 μg/μl) was precleared with 50 μl protein A-Sepharose beads (Upstate Biotechnology, NY, USA) for 2 h at 4°C. An appropriate amount of rabbit anti-Kir2.1 antibody (Alomone) or rabbit non-specific IgG (Santa) was then added and incubated overnight at 4°C. Then, 100 μl preblocked agarose beads was added to the antibody/lysate mixture and incubated for another 2 h at 4°C; the beads were then pelleted and washed twice with lysis buffer. Both the cell lysates without IP and the immunoprecipitates were eluted in SDS sample buffer, subjected to SDS-PAGE and analyzed by immunoblotting.
In vivo tumor xenograft model
Six- to eight-week-old female BALB/c nude mice (purchased from the Medical Experimental Animal Center of Guangdong Province, China) were used for in vivo assays. The mice were raised under pathogen-free conditions, and all procedures were performed according to the guidelines of the Association for the Assessment and Accreditation of Laboratory Animal Care International. Cells were harvested, washed with PBS and re-suspended in normal culture medium at a concentration of 1 × 107 cells/0.1 ml. Cells in RPMI 1640 were subcutaneously inoculated into the legs of nude mice to establish the tumor model. The tumor volume was determined three times per week by direct measurement with a sliding caliper and was calculated using the following equation: V = (4/3) × π × R12× R2, where R1 is radius 1, R2 is radius 2, and R1 < R2. Growth curves of the tumors were constructed. After 20 days, 5 mice from each group were sacrificed, and the tumors were excised and fixed with neutral phosphate-buffered formalin. Subsequently, consecutive tissue sections from the tumors were sliced and then stained with hematoxylin-eosin.
Statistical analysis
All experiments were run in triplicate, and the results are presented as the mean ± SD. Statistical analyses were performed using either an analysis of variance (ANOVA) or Student's t test. The association between Kir2.1or MRP1/ABCC1 or miR-7expression and clinical features was analyzed by χ
2 test. The relationship between Kir2.1 and MRP1/ABCC1 was explored by χ
2 test. Survival curves were obtained by Kaplain-Meier analysis. The positive rate of Kir2.1 and MRP1/ABCC1 in normal lung tissue was compared with that in SCLC tissue by χ
2 test. A difference was considered statistically significant when the P value was less than 0.05. All statistical analyses were carried out with SPSS 17.0 software.
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Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
HL carried out the experimental work and drafted the manuscript. JH performed the statistical analysis and drafted the manuscript. JP collected clinical specimens and participated in the molecular biology studies. XW participated in cell proliferation assays and animal experiments. YZ helped to carry out the immunohistochemistry assays. WZ participated in the collection of clinical specimens. LG designed the study and critically revised the manuscript. All authors read and approved the final manuscript.